The quality of the clinical interaction is a critical aspect of health care, particularly mental health care. A high quality clinical interaction helps build a positive therapeutic alliance and improves patient and family adherence to clinical recommendations. This issue is particularly critical (AI) children and adolescents with mental health problems, whose families struggle with an overburdened system that is staffed by largely non- AI clinicians. A crucial component of the clinical interaction for children's health services, including mental health services, is the interaction between the clinician and the parent. Parents are responsible for assuring that their children attend appointments, take prescribed medications, and are often the focus of clinical intervention themselves. Therefore, when a non-AI clinician interacts with an AI parent, it is critical that clinician behaves in a culturally appropriate manner. This is often challenging as AI cultures are notably different from non-AI cultures in a variety of ways. These differences include the rules governing social interaction and discussion of issues such as illness and death. Concepts of mental illness and time also differ from non-Indian concepts. Cultural appropriateness is thus a critical component of the quality of the process of mental health care, and should be a focus of both scientific inquiry and efforts towards quality improvement. Therefore, the specific aim of this project is as follows: to develop a reliable and valid measure of the cultural appropriateness of clinical interactions for children's mental health services from the perspective of AI parents. Once developed, this measure will be combined with existing investigative tools to pursue critical research studies of the determinants of the quality of mental health care for AI children and adolescents. Providers of mental health services will also find this measure and important tool for quality improvement. As cultural appropriateness is a critical component of quality of care in all health care settings, this measure will allow researchers and administrators, and clinicians working in other health care settings such as family practice and pediatrics to study and address this issue as well.